Healthcare Provider Details

I. General information

NPI: 1790769891
Provider Name (Legal Business Name): BACH T VU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 LONG BEACH BLVD RAD-IMAGE MEDICAL GROUP
LONG BEACH CA
90807-2003
US

IV. Provider business mailing address

4241 LONG BEACH BLVD RAD-IMAGE MEDICAL GROUP
LONG BEACH CA
90807-2003
US

V. Phone/Fax

Practice location:
  • Phone: 562-912-2507
  • Fax: 484-918-2507
Mailing address:
  • Phone: 562-912-5250
  • Fax: 484-918-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG81142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: